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Sixty children aged 8 to 11 years in Belfast (Lancet2000;355:537–41) had reading delay and moved their outstretched arms or lost their balance when their heads were turned with their eyes closed. In a randomised trial, a programme of voluntary movements intended to replicate those of the asymmetrical tonic neck reflex and other primitive reflexes reduced the limb and balance response to head turning and apparently improved the children's reading skills in comparison with control groups. It's difficult to argue with success, but Lucina has difficulty in imagining the mechanisms by which such a movement programme might affect reading ability.
A 10 week programme of moderate exercise and dieting(New England Journal of Medicine2000;342:449–53) brought about weight loss of about 4.9 kg in overweight mothers in North Carolina whose babies were 4 weeks old at the start of the programme. There was no significant effect on the growth in weight or length of the babies compared with those of control mothers.
Women with high plasma phenylalanine concentrations should aim to achieve metabolic control before pregnancy, or as early as possible during pregnancy. A study of the 253 children of 205 such women in the USA, Canada, and Germany (Journal of the American Medical Association 2000;283:756–62) has shown a fall in cognitive functioning with increasing delay in achieving metabolic control in pregnancy. Mean cognitive index score at age 4 years was 99 with metabolic control (plasma phenylalanine 605 μmol/l or less) before pregnancy, 89 with metabolic control at weeks 0 to 10 of pregnancy, 84 at weeks 10 to 20, and 71 if the plasma phenylalanine was never controlled or only controlled after week 20. The mean score of children whose mothers had normal plasma phenylalanine concentrations was 107.
In two areas of Los Angeles, paramedics used bag and mask ventilation on odd days and endotracheal intubation (after initial bag and mask) on even days (Journal of the American Medical Association 2000;283:783–90) when resuscitating children outside hospital. There was no difference between the two groups as regards survival or neurological outcome.
Of 1000 consecutive patients treated at the University of Michigan with extracorporeal membrane oxygenation between 1980 and 1998 (Journal of the American Medical Association2000;283:904–8), 586 were neonates, 137 older children, and 177 adults. Eighty eight per cent of the neonates and 70% of the older children with respiratory failure survived to leave hospital. Adults and patients with heart failure did less well.
A pharmaceutical industry based survey of 23 333 children receiving growth hormone treatment (Lancet2000;355:610–13) revealed 11 with type 1 diabetes, 18 with type 2 diabetes, and 14 with impaired glucose tolerance. Compared with reference data, the incidence of type 1 diabetes was not increased, but that of type 2 diabetes was increased sixfold at 34 cases per 100 000 treatment years. The diabetes persisted on stopping growth hormone treatment.
Of 248 American neonates with persistent pulmonary hypertension and an oxygenation index of 25 or more, 126 were randomised to inhaled nitric oxide (NO) and 122 to no NO. (New England Journal of Medicine 2000;342:469–74). Extracorporeal membrane oxygenation was used in 38% of the NO group and 64% of controls. Chronic lung disease developed in 7%v 20%, but 30 day mortality was virtually the same (7% v 8%) in the two groups.
In a US multicentre trial (New England Journal of Medicine 2000;342:763–9) 51 of 69 patients with polyarticular juvenile chronic arthritis who had not responded to methotrexate treatment responded to open label etanercept (a tumour necrosis factor receptor blocking protein). These 51 were then randomised to etanercept or placebo for another four months and relapse occurred in 21 of 26 in the placebo group and 7 of 25 in the etanercept group. The treatment was well tolerated.
Commendable efforts to improve or maintain levels of vaccine coverage may lead to some children being given more than the recommended number of doses. In a national US study (Journal of the American Medical Association2000;283:1311–7) 21% of children had received extra doses of at least one vaccine and 31% had received fewer doses than recommended. The annual cost of the extra doses was estimated to be at least US $26.5 million. Part of the problem is that children may receive immunisations from more than one source.
In young women in Minnesota with bulimia nervosa (Lancet2000;355: 792–7) ondansetron halved the rate of bulimic/vomiting episodes (from 13/week to 6.5/week). It is postulated that the effect was mediated via a reduction in vagal afferent activity. Whether they felt better for it is not stated.
A trial in South Africa (Lancet2000;355:798–803) has shown that repeat measles vaccination of schoolchildren using an aerosol delivered via a nebuliser is effective and practicable. The Edmonston-Zagreb, but not the Schwarz, vaccine retained its potency on nebulisation. The method avoids the risks of injection in developing countries and could help to achieve measles eradication.
Invasive pneumococcal disease preferentially affects young children and the elderly but a US/Canadian study of non-elderly adults (New England Journal of Medicine2000;342:681–9) has re-emphasised the effect of smoking. In this population, the adjusted population attributable risk for invasive pneumococcal disease was 51% for cigarette smoking and 17% for passive smoking.
In 44 centres throughout Europe between 1989 and 1994, the age and sex standardised incidence of childhood (< 15 years) diabetes averaged about 12 cases/100 000 population years (Lancet2000;355:873–6) but it varied from 3.2–40.2 cases/100 000 /year. There was a trend to high rates in north and north west Europe and low rates in the south and south east. The incidence in English centres averaged about 16/100 000/year. Some countries showed little change over the period of study but the average annual rate of increase in incidence was 3.4%. The increase was faster in younger children (6.3% for the under 5s, 3.1% for 5–9 year olds, and 2.4% for 10–14 year olds.
Laboratory work in Spain (Nature Medicine2000;6:313–9) has suggested that cannabis might have a role in the treatment of gliomas. Tumours were generated in rodent brains by injecting glioma cells into the brain or subcutaneously. When the tumours were established, cannabinoid was injected into the tumour. The tumour was eradicated in a third of the animals and survival was prolonged in another third. The drug is thought to act via a pathway involving increased production of ceramide.